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The Impact of Blood Pressure and Blood Loss in Deep Inferior Epigastric Perforator Flap Surgery: Insights from 206
Hanna Fritsch1, Cosima Schreiber2, Wolfram Malter2
1From the Department of Gynecology and Obstetricts, Breast Cancer Clinic, St. Franziskus Hospital Muenster, Muenster, Germany.
Background:
Autologous breast reconstruction using the deep inferior epigastric perforator flap is a key procedure in modern oncoplastic surgery, particularly for women after radiotherapy and mastectomy. The influence of intraoperative blood loss and blood pressure management using catecholamines remains controversial. This study analyzed postoperative blood pressure management and blood loss, hypothesizing that neither catecholamine use nor blood loss (defined by the mean hemoglobin difference) adversely affects surgical outcomes or complication rates.
Methods:
A retrospective, multicenter study was conducted, evaluating intraoperative blood loss and postoperative catecholamine use as primary endpoints. Secondary endpoints included major complications (flap loss) and minor complications. A total of 194 patients (206 flaps) were included-180 unilateral and 13 bilateral reconstructions-performed between 2014 and 2018 at 2 German centers. Subgroups were defined by catecholamine administration, including all 206 cases. Blood loss was calculated for 199 cases, based on perioperative hemoglobin differences. Both subgroups were analyzed for confounding factors and outcome differences.
Results:
Overall, 6 total flap losses (2.9%) occurred among 206 flaps. Neither intraoperative blood loss nor postoperative catecholamine use significantly affected flap survival or complication rates. No significant differences were found between subgroups regarding overall complications.
Conclusions:
This analysis confirms the deep inferior epigastric perforator flap as a reliable and safe reconstructive technique with low complication rates. According to our findings, intraoperative blood loss and postoperative catecholamine administration do not significantly influence surgical outcomes, supporting the safety of hemodynamic management strategies commonly used in clinical practice.
